Connecting Communities Collaborative

Connecting Communities Collaborative The Critical Role of HIEs in Disaster Response October 26, 2017 2 pm 3 pm ET

Agenda Welcome and Introductions Jennifer Covich Bordenick, CEO, ehealth Initiative Discussion & Comments Doug Dietzman Executive Director for Great Lakes Health Connect (GLHC), ehi Leadership Nick Bonvino Chief Executive Officer, Healthconnect Phil Beckett, PhD Chief Information Officer, HASA Health Information Organization Questions & Answers

Housekeeping Issues All participants are muted To ask a question or make a comment, please submit via the Q&A feature and we will address as many as possible after the presentations. Technical difficulties: Use the chat box and we will respond as soon as possible Today s slides will be available for download on ehi s Resource page www.ehidc.org/resources

Our Mission ehealth Initiative's mission is to serve as the industry leader convening executives from multistakeholder groups to identify best practices to transform healthcare through use of technology and innovation. ehi conducts, research, education and advocacy activities to support the transformation of healthcare. 4

Multi-stakeholder Leaders in Every Sector of Healthcare

Roadmap to Transforming Care OUTPUTS & RECOMMEND ATIONS Guidance, Education, Reports RESEARCH Information Gathering, Surveys, Interviews CONVENE - Exec Roundtables, Committees, Webinars, Workgroups 6

Convening Executives To Research & Identify Best Practices Best Practice Committees Identify & Disseminate SuccessStories INTEROPERABILITY DATA ACCESS & PRIVACY PATIENT & PROVIDER TECHNOLOGY ADOPTION DATA ANALYTICS

ehealth Resource Center Available With Best Practices & Findings Best Practice Committees contribute to the ehealth Resource Center www.ehidc.org/resources which provides assistance, education and information to organizations transforming healthcare through the use of information, technology and innovation. The Resource Center is a compilation of reports, presentations, survey results, best practices and case studies from the last 16 years.

Electronic Medication Adherence Collaborative (emac) Foundation for ehealth Initiative launched a multi-stakeholder Electronic Medication Adherence Collaborative (emac). Share best practice examples from different analytical and behavioral approaches, educate stakeholders on the insights available. Share information on the effectiveness of programs. IN PERSON MEETING ON DECEMBER 12 IN DC. INTERESTED? TELL CLAUDIA.ELLISON@EHIDC.ORG 9

Save the Date: February 7 8, 2018 Top of the Hill, Washington, DC ehealth Initiative Executive Summit: 2020 Roadmap Refresh Attendance is limited to ehealth Initiative members and invited C-Level Executives

Mission The Collaborative will provide participants an opportunity to engage in a forum to share ideas and learn best practices through monthly virtual meetings

Key Activities Provide broad support to health care improvement activities through ehi s multi-stakeholder collaborative forum Create a learning community for those interested in exploring the use of electronic health information to support health care Widely disseminate information using a wide range of mechanisms, including ehi s Resource Center Develop policy recommendations to clear barriers to and accelerate adoption

Doug Dietzman Executive Director for Great Lakes Health Connect (GLHC)

Coordinating Care Across Our Community: in Good Times and in Bad Local Health Information Exchange Response to Hurricane Harvey Connecting Communities Collaborative Thursday, October 26, 2017 Nick Bonvino Chief Executive Officer Healthconnect

Regional Health Information Exchange Hospital Laboratory Specialist Our Mission: Coordinate Care by Connecting ALL Providers WE are Southeast TX s HIE Free Standing ED Healthconnect Clinic WE integrate disparate EHRs across the community WE enable the query for health information across the ecosystem Primary Care Physician WE serve as the foundation for Population Health Management Pharmacy Radiology Center WE facilitate data exchange to better inform decisions made at the point of care 15

HIE Healthconnect Footprint Our Geography *Our Collaborators Our Reach 23 Counties 50%+ Hospitals 40%+ Physicians 5+ Million Patients 300+ Fully-Executed Participation Agreements 500+ Care Venues *A representative sample of our 500+ participants 16

Healthconnect Services Health Information Exchange Diagnostic Imaging Exchange Healthcare Notifications Health Information Service Provider (HISP) Query and retrieve patient records from across the healthcare ecosystem Cloud-based image exchange that enables viewing and sharing of medical images Real-time alerts when patients admitted, discharged or transferred toand-from facilities Direct Secure Messaging between providers Member of DirectTrust and the Trust Bundle 17

No Regional HIE Model Laboratory Hospital Specialist Our World Without an HIE Free Standing ED Clinic Massive amount of pointto-point connections Higher costs to implement and maintain Primary Care Physician Pharmacy Radiology Center Complex to manage Inefficient to coordinate all care 18

Healthconnect Model Laboratory Hospital Specialist Our World With an HIE Free Standing ED Primary Care Physician Healthconnect Clinic One connection Lower costs Improved efficiencies Greater care coordination The Hub of all data activity Pharmacy Radiology Center 19

Hurricane Harvey 20

Hurricane Harvey Overview August 25-29, Hurricane Harvey hits the Gulf Coast of Texas The storm moves east and stalls over the Houston area, with record 52 rainfall Significant devastation and flooding along the coast and inland Corpus Christi, Greater Houston, and Beaumont/Port Arthur most impacted Storm eventually moved on to Louisiana 21

Hurricane Harvey Shelter Setup Megashelters established across state to support 30,000+ evacuees: Houston 2 shelters, 14,000+ Dallas 1 shelter, 4,000+ San Antonio 1 shelter, 2,800+ Austin 1 shelter 22

Hurricane Harvey Pressing Need for Medical Histories Shelters quickly swelled with evacuees Many evacuees required medical attention An urgent need arose for access to patient medical information and practice without an EHR! 23

Hurricane Harvey Mobilization Portal Provisioning Shelters Call-In Operations CHI St Luke s request to provision additional clinicians at all locations ahead of storm Coordinate with other HIEs - portal and support for call-ins Coverage San Antonio, Austin, Corpus Christi, Beaumont -Port Arthur, Tyler-Texarkana, DFW Monday organized for need Tuesday on-site with evacuees and volunteer clinicians - Confirmed consent and queried for PHI at point-of-care 24x7 thru weekend Embedded HIE into triage and clinical workflow. Coordination with Federal DMAT & FMS teams Remote calls from clinicians to look-up PHI. Read results or send secure email 24x7 support for 17 days All hands on deck GHH staff and alumni worked after-hours and weekend shifts 24

Hurricane Harvey Vignettes As hospitals became overloaded with phone calls, we became de facto source for information Similarly, with many pharmacies closed, we were the source for medication data I will definitely write very positive things about GHH in my post-storm report - Ted Sikorski, MD DMAT Commander Most physicians surprised by our capabilities We were only ones with computers Patient MO: diabetics, CV, dialysis Common requests: medications, problem list, labs, notes, radiology Steady flow 20+ patients / hr Call-in operations response time to requests, <2 mins GHH staff and alumni volunteered time 25

Hurricane Harvey Impact 937 staff hours to support shelters 17 # of consecutive days with 24/7 call-in support 100% patients who opted in when asked for consent at shelters 653 70% 62% total # of records accessed during Harvey Records found as % of total requested Query requests just looking for active medications 26

Hurricane Harvey Key Learnings Observations In chaos, no time to wait, asserted ourselves in Medical teams quickly incorporated us into workflow Rapid state-wide mobilization for call-in support The power of organic participation Frustrations No access to the few hospitals not connected Some returned CCDs were incomplete Patients in the MPI, but not consented to share We wanted to do more, but resources spread thin Interesting Use Cases Leveraging HIE to determine evacuee identity Using ADT to determine evacuee location Used CCD and recent encounter for TB look-up Enabled provider to access their EHR thru our laptop The Future Participation from ALL healthcare providers Providers improve documentation in CCDs Coordination and connectivity throughout state Incorporate and fund HIEs in Emergency Management Programs at the Fed, State, and Local levels 27

The Importance of a Community HIE 28

Nation-wide HIE Programs Initiatives claim interoperability across all EHRs and no need for local HIEs However, our experience suggests there are serious flaws AND, the hurricane reinforces the critical importance of local HIE capability in disaster preparedness! 29

Top 5 Flaws in Nation-Wide Initiatives 1 2 Insufficient Patient Matching Can t Manage Patient Consent Consistently NATIONAL On-the-fly query sends 5 patient attributes statistically insufficient Variation in patient consent models among participants LOCAL HIE ADT feed builds CMPI in advance of query 18 attributes and probabilistic algorithm Opt-in model: informed consent response stored and managed in CMPI 3 Returning Multiple CCDs to Provider Cannot Support 4 Not possible Notification Services Delivering 1 CCDs from each EHR will overload caregivers resulting in missed information CCDs aggregated into a single on-demand document: data normalized, de-duplicated, and more easily reconciled into EHR Real-time alerts enabled by ADT feeds Timing of events not just the data Essential for managing at risk populations 5 No Clinical Portal Not possible Online portal for clinical information Access to clinical info w/o EHR connectivity Population health use cases 30

Community HIE Patient Matching Free Standing ED Hospital ADT feed ADT feed Laboratory Healthconnect Community Master Patient Index ADT feed Specialist Clinic Uniquely identify Patients Across the Community ADT feeds from all Participants builds Community MPI 18 attributes for each patient used to overcome source data issues Primary Care Physician ADT feed Populations in excess of 500,000 require probabilistic matching algorithms Pharmacy Radiology Center Work que - Manual review of probable matches 31

Community HIE Managing Patient Consent Hospital ADT feed Laboratory Specialist GHH Consistently Manages Consent Across the Community Free Standing ED ADT feed Healthconnect ADT feed Clinic Primary Care Physician ADT feed Pharmacy Radiology Center 32

Community HIE On-Demand Clinical Documents Laboratory Free Standing ED Hospital Primary Care Physician Healthconnect Specialist Clinic Record locator identifies patient encounters pre-query Participants respond with C-CDA and may contribute data feeds Data is parsed, normalized, deduplicated, and consolidated into a single C-CDA Common style-sheet and standards ease reconciliation into EHR Pharmacy Radiology Center GHH Responds to Requestor *time from query to response is a few secs 33

Community HIE Notification Services Laboratory Hospital ADT feed Specialist 1 Participant identifies patients to be monitored Free Standing ED Primary Care Physician ADT feed Healthconnect Notifications ADT feed ADT feed Clinic 2 3 GHH CMPI fed real-time with all patient registrations and activity via ADT feeds Upon patient and ADT match, alert is generated and pushed to Participant as desired Pharmacy Radiology Center 34

Community HIE Online Clinical Viewer Hospital Laboratory Online Clinical Portal Specialist Free Standing ED Healthconnect Primary Care Physician Clinic Allows providers secure online access to all patient information View clinical data without an EHR Pharmacy Radiology Center Care navigators can follow-up on alerts viewing patient encounters from across community in 1 place 35

Thank You! 36

HASA Experience Phil Beckett, PhD, CIO HASA 37

HASA Data Flow - 2017

Shelter Experience HASA set up onsite at Dallas Megashelter with a laptop/printer next to medical triage for direct requests from providers in the shelter Informed rotating staff of our capabilities Upon request, patient records were retrieved from either HASA or GHH based on patients home, and necessary follow-up calls were made Became part of medical command team 39

Shelter Observations Medical support is primarily for acute cases and stress related, need for history is closer to arrival at shelter Many facilities lacked technology resources (no fax, no PC, no internet, etc.) Multiple medical organizations were directing operations Professionally organized, large collaborations 40

Stories A patient taking anticoagulants but was unsure which one and what dose. The physician wanted to know the history, prescriptions and INR values. Through the HIE, a physician portal and a call to the patient's pharmacy we were able to assimilate enough information for the physician to accurately treat the patient. 61-year-old female with recent hip surgery presented at the clinic without good recall of immediate past medical history. She was hurting and feeling poorly. Searched HIE and pulled off active meds list from last month s surgery and a medication allergy list that included hydrocodone and amoxicillin. The physician was glad to know about the pain and antibiotic allergies given her current condition. 10-year-old pediatric patient with mental health issues. He was at the shelter with his mother, who was not his primary caregiver. They brought no medication and he was becoming aggressive. Mother did not know meds or physician names. Psychiatrist needed meds list to determine prescription type and dosages. Was able to pull meds list from HIE. 41

Stories Cont. A patient presented to the shelter clinic looking for treatment for their cancer. Triage asked if I could find the meds list. There was no information in the HIE related to cancer and no meds list, so they decided to track down the doctor. We were able to eventually get her provider and call them directly. The doctor in her home town told us she did NOT have cancer, and is on a pain management contract for drug seeking. Patient was discharged without prescribing pain medicine. This was a good combination of having data in the HIE, plus people adding manual efforts to track down local providers. A displaced minor without his parent/guardian who suffered with asthma could not remember his inhaler type or allergies. I was able to find his mother's phone number in the HIE, call her, reunite her with her son (by phone) and document his nebulizer and allergies as reported by his mom. He asked for a copy so that he could share it as appropriate with support members at the shelter. A patient with diabetes did not have his insulin available or remember the dose and type or regimen. Through the HIE we were able to find his records and the insulin he had been prescribed. The physician was then able to help the patient restart his normal insulin regimen. 42

Lessons Learned Interoperability/Patient Centered Data Home is KEY! For future disaster situations, 100% contribution is necessary for system to be fully effective Access to patient data needs to be minimally invasive and easily accessible utilizing the capabilities at hand (sometimes limited to cell phone) HIE should be part of statewide disaster planning in the future Solution in case of power / internet outage 43

Next Steps Continued engagement with Dallas shelter to work on digitizing and storing approx. 2,000 intake and medical records forms, as well as continued access to HIE data for telemedicine efforts with evacuees Development of disaster smartphone application/mobile-ready website that provides appropriate access to patient history Use the opportunity to become part of disaster management teams for shelters in future and to push for statewide interoperability 44

Call to Action Floods in Texas, fires in California, earthquakes in Utah displacement of people without time to grab essentials can be a reality anywhere. Access to a patient record may be critical. Like any emergency response, preparation of the infrastructure is the key to success. Regional HIEs have the capability and the boots on the ground to help facilitate emergency response in their local community. Health care providers join your regional HIE, it will help your patients when there is no disaster, and critically if there is one. 45

Q&A